The human heart beats approximately 100,000 times per day, causing blood to course throughout the body on a mission to nourish the cells with oxygen and remove waste products. The heart is by far the hardest working and most vital muscle in the body.

That is why a clot in one of the arteries that feeds the heart is such a devastating medical event. When a coronary artery is blocked, the result is an acute heart attack — a myocardial infarction in medical terms. When this occurs, swift, life saving intervention is the best hope for survival. The gold standard for that intervention — coronary angioplasty with stent placement — has been available at Huntington Hospital since October 2004.

Huntington Hospital’s goal is to ensure that patients who come to the emergency department experiencing a heart attack are treated with coronary angioplasty in the cardiac catheterization laboratory within 90 minutes, conforming to most recent national standards for optimal treatment.

The most important part of this process is awareness on the part of the patient, and willingness to come to the hospital to investigate potential cardiac symptoms, particularly in those who view themselves as too young or healthy to be having a heart attack.

“There is a misconception that a heart attack feels like a lightening bolt,” noted interventional cardiologist Raj Patcha, MD, on-site Director of Huntington Hospital’s Cardiac Catheterization Laboratory. “In reality, symptoms can often be subtle. Some people report only a vague sense of discomfort or slight pressure, as if they are wearing a t-shirt that is too small.”

Above: Image of a blocked coronary artery (top) and the same artery after the blockage has been treated with a balloon and a stent (bottom). Blood flow has been restored through the vessel Which resembles the letter “c” on the left side of the image.

“Patients who tell the triage nurse that they are having chest pain and need an EKG will be fast tracked in our Emergency Department. Our goal is to obtain an electrocardiogram within five minutes of arrival,” said Jeff Weigers, RN, Director of Cardiac Services. The electrocardiogram can confirm and define the location of the coronary artery blockage. This finding triggers a call to the interventional cardiologist and the cardiac catheterization team via a universal page, regardless of the hour of the day or night. The team’s ability to respond immediately is critical, since three out of four emergency angioplasties occur outside of the cardiac catheterization lab’s normal operating hours.

The team, on call on a “24/7” basis, includes an interventional cardiologist — Huntington Hospital’s staff includes three of these specially trained physicians, Dr. Patcha; Brian Strizik, MD; and Ramanjit Bagga, MD; additional coverage is provided by interventional cardiologists affiliated with the North Shore-LIJ Health System, as needed — as well as two registered nurses and one professional x-ray technologist to act as a cardiac monitor.

What unfolds within the cardiac catheterization laboratory is dramatic. Using contrast dye injected into the involved coronary artery via a catheter inserted from an artery in the thigh, physicians obtain real-time, moving images of the coronary artery and are able to visualize the blockage. Then, by inserting a balloon followed by a collapsed metal mesh tube, called a stent, into the area of the blockage and deploying it, they re-open the narrowed artery. The team is able to observe the digital monitor as blood flow is restored to the involved artery of the heart.

After the procedure, the patient is monitored on the Cardiac Care Unit for two to four days before returning home.

The development of stents in the early 1990s laid the groundwork for community hospitals without open heart surgery programs to perform primary angioplasty in the treatment of heart attack.

“In the early days of coronary angioplasty, when a balloon was used to open the artery, in about five percent of cases the artery would close immediately upon deflation of the balloon and patients would require emergency bypass surgery,” Dr. Patcha observed. Stents keep the artery open, even after the balloon tipped catheter is removed.

On the drawing board for Huntington Hospital is the construction of a second angiographic laboratory which would be used for cardiac catheterization, peripheral angiographic diagnostic and interventional studies as well as Electrophysiology procedures including permanent pacemaker and defibrillator implantation in the treatment of heart rhythm disturbances.

“Emergency coronary angioplasty has reduced the risk of death from a heart attack by 50 percent,” Dr. Patcha concluded. “But if patients don’t come to the hospital promptly, they cannot benefit from these advances. Once the artery is closed, there is zero blood flow to the affected part of the heart. Every minute that passes brings more irreversible damage to the heart muscle.

Healthline July 2008